Healthcare Provider Details

I. General information

NPI: 1487638557
Provider Name (Legal Business Name): DOUGLAS A DONALD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 THORN RUN RD
MOON TWP PA
15108-4301
US

IV. Provider business mailing address

279 NEWBURN DR
PITTSBURGH PA
15216-1229
US

V. Phone/Fax

Practice location:
  • Phone: 412-269-2275
  • Fax: 412-269-2276
Mailing address:
  • Phone: 412-344-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008248
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: